Severe depression and the magic of medicine.

I’m going to take a day off to hang out with my fiancee and my brother.  However, I did want to post this one thing.  Eight months ago I received an email from a guy, let’s call him John Wayne, who was suffering from severe depression.

Hi JT,

Big fan, longtime follower. I’m sure you get a ton of messages everyday so I’ll understand if you don’t respond. I’ve been following your blogs/FB for a while now and I while I’m a huge admirer of your writings and message in regards to Atheism. However, my question is one in regards to a medical issue.

I’m a 40 year old kid-at-heart but 4 years ago I was diagnosed with severe depression. I didn’t work for 8 months and I was on anti-depression medication. I ran into the same issues that you’ve mentioned, having this ‘fuzzy brain’ all the time and having some memory issues when I returned to work. I’m a programmer by trade, so you can see how I rely on my memory. It got so bad that I weened myself off of the medication and I’m now medication free since January of 2010. I’m pretty much forced to handle my depression through willpower, and most of the time I’m OK. Those times/days that are hard, though, not so much. I get through them, though, by forcing my mind to think through the depression. But those hard days make working very, very difficult. Being off the medication helped with my memory, but I still struggle and it’s not as good as before my depression. The fuzziness is gone, but I struggle with motivation and focus. Add in the getting through it with willpower and you can see how exhausting it can be for me day-to-day.

You mentioned that you were switched to Wellbutrin a while ago. I just talked to my doctor last week and he mentioned that he’d like me to consider it. I was hoping you could give an update on how it’s going being on this medicine. My doctor is impressed that I’m so in-touch with how my mind works and how I feel at any moment, but he feels that 6 to 12 months on Wellbutrin will give me a boost and help me without the memory and focus side effects. Have you noticed anything positive being on this medication?

Anyways, I thought I’d ask to see how the drug has helped or not for your recovery. Like I mentioned earlier, I’m a huge admirer of your work so I thought I’d ask. One of these days I’m going to attend a CON and I look forward to meeting you in person. Until then, keep up the great work! You, my friend, make a difference is so many lives. Have a great day and thanks for reading/listening.

I wrote back:

Mr. Wayne,

Thanks for the accolades.

I was allergic to Wellbutrin, but I’ve heard it can work much better for mitigating depression while improving focus. Lexapro has a similar reputation and it just went generic. It is widely accepted that Lexapro has the lowest side effect panel of all SSRIs.

You may also consider going with a cocktail. Christina takes Lexapro for the depression and Aderall for focus. It works like a dream. I’d ask your doctor about all of the above.

Good luck and let me know how it goes.

JT

We exchanged a few more emails with small talk.  Today he sent me an update:

Hi JT,

My 8 months later update..heheh…

I actually waited a couple more months before I went with my prescription of Wellbutrin. I thought I could tough it out but it kinda got a lot worse. At that point I realized I was heading for trouble and needed help.

I’m on a low dosage, and most days I’m doing pretty good. My ‘hard’ days, which used to be once or twice a week, are down to about once every three or four weeks. This is great news but they seem to always happen around the time I’m thinking I’m doing better. Go figure. The side effects for me aren’t bad at all. I do suffer from insomnia sometimes, but that’s only every few weeks and it doesn’t last all night. I didn’t get the good perk of weight loss… I’m still fighting my over-eating ways. Ah well.

The only issue I still have is focus/memory. I don’t think it’s gotten better or worse. I just talked to my doc about it last week and he reassured me that it’s normal. I’m not so sure… I’m a programmer and I’ve been working with the same codebase for over a year now and I still have trouble remembering variables and class names and such. I work through it, and if this keeps up I may need to see a different doctor.

The good news:
I am happy most of the time. My social anxiety rarely rears it’s ugly head when I’m out and about, and when it does I’m able to control it. My wife says that she has noticed a difference and it helped me when I convinced her to see a doctor about depression. She’s only been on meds a month or so now and she’s still not sure about it. She’s on a different brand (I forget which). She’s slowly showing signs of improvement. I’m just glad she’s finally coming out of the ‘lows’…

My youngest is doing great. He was initially in a school for a few hours a day (he was 3 at the time) and when our Minnesota Aid finally got approved he qualified for the Minnesota Autism Center and he’s been going there every M-F, eight hours a day, for almost two months now. In that time he’s started to speak and say words and show huge signs of improvement. In fact, the other day at our parent meeting they informed us that his six month therapy plan wasn’t challenging enough so they had to rewrite it. He’s very high on the spectrum and they’re very focused and optimistic that he may be one of the rare ones that may get off the spectrum. They just had a young boy ‘graduate’ off the spectrum a couple months ago.

Anyways, sorry it took so long for an update. I’m still a HUGE fan. I read your site daily, and I’m always looking forward to the day when I can get away from my little spawn and see you do a conference in person. Keep up the great work! You truly are a great inspiration for a lot of people!

Thanks,
J.W.

Managing clinical depression is a process.  It certainly takes time – hell, it took me years.  But with medication and treatment, like any other disease, it does get better.

I know how scary and hard it can be if you’re suffering from depression, how you can feel so weak at the thought of going to a doctor instead of just toughing it out.  But believe me when I say there is no shame and a high probability that you can eventually enjoy the world in which you live.

You deserve to be happy.  You deserve to be well.  If you suspect you may be clinically depressed, going to the doctor is the best decision you could make.

  • aoscott

    Great post – glad to hear this guy is managing OK.

    I think a lot of people suffering from depression need to just talk about these things with any social support they have. Seeing a psychiatrist in addition to regular therapy visits can be so helpful, but it takes time like you mentioned.

    Also it needs to be said that there is no one drug or combination (or as you noted, ‘cocktail’) that is going to fix everything for you; it’s a process. Finding the right medications that work for you in addition to therapy takes time, but if you can stick with it you’ll see some great results.

  • GaryLayng

    Your and Mr. Wayne’s struggles with depression remind me of my fellow diabetics’ struggles with controlling their glucose levels – up one day, down the other. By rigidly following my diet and my insulin dosage, mine has been under control since some weeks after initial diagnosis last summer.

    I hope that your and his regimen works as well with your disease as mine is doing with my disease.

    • rovinrockhound

      It is remarkably similar how “wellness” in both diabetes and depression can fluctuate quickly, affected by little events in our daily lives and often any number of unknown factors. Blood sugar, though, is something you can measure and fix instantaneously. Depression doesn’t have a measure like that. Sure, maybe now you can get out of bed when last week you couldn’t, but sometimes it’s really hard to know if the depression is worse or if you are just a bit down today, like everybody is sometimes.

      I really wish depression responded to chocolate like low blood sugar does. I try it anyway – screw evidence-based medicine! It might be purely placebo, but pretzels dipped in Nutella or a square (half a bar, let’s be honest) of Lindt dark chocolate with passion fruit do make life better. :)

  • rovinrockhound

    JT, you rock (as usual). Hearing other people speak openly about their own troubles managing depression gives hope to those of us who are struggling to get through setbacks in our treatments. The thought of fully relapsing is so terrifying that any minor slip can easily get blown out of proportion, so hearing of others improving makes being fully well seem like an attainable goal.

    Mr. Wayne, you sound a bit like me. SSRIs were a disaster (I spent a month on Lexapro and was too stoned to remember anything and too unconcerned to get off the med), but Wellbutrin has worked wonders for 2 years. It definitely improved focus (but not memory) and really helped social anxiety. The depression wasn’t fully lifting so a few months ago I got tested for ADHD and added Vyvanse (extended release Adderall). Memory and focus improved, mood is better, and anxiety is completely gone (within 2 hours of the first pill – really). It turns out that the inside of my head is really freaking loud (the H in ADHD). The stimulants turn that off and now I can think (and process negative emotions without them getting amplified by the racing thoughts). Wellbutrin and methamphetamines are both thought to work on dopamine and norepinephrine, so adding a stimulant to Wellbutrin could help if an SSRI doesn’t. Good luck!

  • Amber

    As someone who has never been medicated this is a great piece. I have been afraid of medication for depression/anxiety and sometimes I feel it would be easier with it. These stories let me know it can get better.
    Thanks JT!

  • otrame

    Folks, I’ve been on anti-depressants for nearly 30 years. I can tell you what I tell everyone:

    1. Meds help but are not a fix-all.

    2. You will probably have to try several meds because none of them are right for everyone.

    3. When you have found one that really works for you, you are not through yet, because it is not infrequent for them to stop working as well after 3-5 years and you have to go through the process again.

    4. Adding other drugs, for instance Provigil or Adderall can definitely help. Adding Deplin which is “pre-digested” folic acid, will help some people with depression a great deal (because some people with depression have been found to be very low in folic acid in their brains and adding tons of it to the diet doesn’t help–so it appears to be a digestive disorder or a mal-absorbtion disorder). It sure made a big difference for me.

    5. Taking meds is NOT A WEAKNESS. I remember when my mother-in-law, after complaining of being terribly depressed, was somewhat insulted when I suggested she see her doctor about anti-depressants. “That’s like using a crutch,” she huffed (knowing full well that I used them). I said, “It’s kind of stupid not to use a crutch when you have a broken leg.”

    6. If your doc or therapist doesn’t take your depression seriously, GET ANOTHER DOC.

    • Nate Frein

      The rest of your reply is awesome, but I love you just for this:

      “It’s kind of stupid not to use a crutch when you have a broken leg.”

    • invivoMark

      Taking meds is NOT A WEAKNESS.

      ^THIS! This, this, this, this, this, this, this, this, and this.

      There is absolutely no reason to suppose that your brain’s optimum functionality is also its default functionality. If you have depression at all, then it’s already not at optimum functionality. Drugs won’t put you right at optimum, but they sure as hell can get you closer.

    • http://avoiceinthewilderness-mcc1789.blogspot.com/ Michael

      What if the medication has no apparent effect?

      • otrame

        See my number 2 above. There are many different kinds, at least one of which will probably work. There are kinds of depression that aren’t helped by current anti depressants, but you won’t know yours is like that if you only try one kind. Also, don’t forget most take a week or more before they are fully effective.

        Most importantly, don’t listen to a stranger on the Internet. Go see your doc.

  • Rebecca A Alvarez

    I have treatment resistant depression and the vagal nerve stimulator with low dose atypical anti-psychotic (seroquel 300 mg) have worked great for me. Deep brain stimulation works for some people, too.

  • Tak

    When I first started working as a psych nurse my depression got so bad I was suicidal daily. I was afraid of meds because I was worried about my license and I was upset that I could ‘let’ myself be ‘weak’ (despite knowing better in my mind my parents were anti psychiatry and their internalized voices still held strong sway) and because of my religious background which just said to me “see? atheists ARE unhappy and this proves it. You can’t make it without god in your heart”…

    … so I struggled until one day I had come up with a foolproof plan, obtained the means, and was setting it up when in a moment of rational thought I decided to call a hotline. Talked to someone for about an hour and decided to postpone the event and see if my doctor could help. The volunteer pointed out that anything meds could do to me would be better than being dead.

    Cut to a year later and a marvelous turn around on zoloft. Still alive and that plan is on an indefinite hold. A few months ago I weaned myself off and am doing ok so far.

    • invivoMark

      And I’m very glad you’re still with us!

    • otrame

      That is a great story. I am happy you made it.

      It also points out that for many people a few months or a few years on the drugs is all you need to sort of “re-set” your brain chemistry and you won’t need it again, or will only need it occasionally for the rest of your life. I, unfortunately, become non-fuctional without meds, but perhaps some day they will come up with something that will fix whatever causes my depression. In the mean time, I went from having to fight myself tooth and nail to get the dishes done after supper to having a career I loved and now I am retired and living an enjoyable life. I have my down days, but they are fairly rare and I know that they will pass, usually within a few hours. Life is good.

  • Carlos Cabanita

    “Graduate out of the spectrum”? I’m very skeptical about it. It is possible to learn the social skills to mitigate most of Asperger’s shortcomings. It must be done the hard and counterintuintive way, as a discipline, as a knowledge and an art, not as an instinctive and natural behavior as neurotypical people do. In the end you may fool the experts because you don’t show the typical signs. But you still are on the spectrum. I know, it’s the story of my life and I make 60 this year.

  • Carlos Cabanita

    I’m also recovering from a major suicidal depression two years ago. A dopamin reuptake blocker works for me (Sertraline). And a very small dose of an anti-epileptic (Topiramate) works as an impulse controller.


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